Epidural anesthesia is a common form of anesthesia used for lower abdominal, pelvic and lower extremity surgery. It is also used to provide pain relief in certain chronic and acute conditions such as during childbirth.
In general, an epidural anesthetic is administered by inserting an epidural catheter into the epidural space located right outside the spinal cord. A standard epidural catheter connector is then attached to the free end of the epidural catheter. Subsequent to this, a standard syringe containing any of several local anesthetics available, is connected directly to the epidural catheter connector. Gradually, a moderate amount of the local anesthetic is injected so that it passes through the epidural catheter and eventually into the epidural space, flooding any nerves as they come out of the spinal cord.
The degree and level of numbness produced is directly proportional to the amount of local anesthetic injected. In some instances, in addition to the above initial dose, a continuous epidural infusion of either local anesthetics or narcotics or both, is initiated. This continuous infusion can provide pain relief for several days and is accomplished by using an epidural pump, a pump bag containing the medication to be given, and also continuous epidural tubing which connects to the epidural catheter connector.
Prior to receiving an epidural anesthetic, all patients have an intravenous line started in order to administer fluids and other medications. This intravenous line has either injection ports along the way or stopcocks or both, through which medications can be given. Injection into an intravenous line port is achieved by using a standard syringe with a needle attached to it. Injection into a stopcock is accomplished by using a standard syringe without a needle.
In summary, standard syringes are now being used to inject medications both into an epidural catheter and into an intravenous line present in the same patient concurrently. If the large quantity of local anesthetic that is intended to be injected into the epidural catheter is accidentally injected into the intravenous line, severe neurologic and cardiovascular problems, up to and including death, can occur.
Alternatively, if some medications that are intended for intravenous use are accidentally injected into the epidural space, the patient may suffer severe temporary or permanent damage depending on the nature of the drug injected.
Anesthesiologists and nurse anesthetists are extremely careful in labelling and using these standard syringes to try to minimize the occurrence of such erroneous injections. However, anesthesiologists and nurse anesthetists are also human, and, despite the most careful precautions, these accidental injections continue to occur.